Palin PCI

Palin Parent-Child Interaction Therapy (Palin PCI)

Overview

  • Presenter: Elaine Kelman, Michael Palin Centre for Stammering, London, UK

  • Goal: Establish foundational communication skills for children, regardless of stuttering, while promoting positive attitudes toward communication and stuttering in the family environment.

Aims of Palin PCI

  • Reduce the overall impact of stuttering on the child and parents.

  • Enhance the fluency of the child’s speech.

  • Increase knowledge of stuttering for both parents and children, fostering confidence in managing it.

Identifying Children Who Need Intervention

Language Descriptors

  • Terms used in classification:

    • Persistent vs. Recovered: Refers to children who continue to stutter versus those who have stopped.

    • Transient vs. Persistent Stuttering: Focus on distinctions between temporary stuttering that resolves and ongoing stuttering.

    • Preference for terminology that denotes stuttering as resolving rather than recovering.

Clinical Decision-Making Evidence

  1. Family History & Gender:

    • Children with a family history of persistent stuttering are more likely to persist, as indicated in research (Ambrose, Cox & Yairi, 1997).

    • Gender ratios vary: similar at onset but shift to a 5/6:1 ratio favoring boys in school-aged children.

    • Note that research displays inconsistent findings regarding persistence in girls.

  2. Duration & Changes Since Onset:

    • Approximately 75% of stuttering in children resolves within 4-5 years post-onset.

    • The likelihood of persistence increases with the duration of stuttering and if the condition remains stable or worsens over time.

  3. Brain Structure & Function:

    • Ongoing research seeks neural markers that may help differentiate between children who will recover and those who will not.

  4. Severity of Stuttering & Age at Onset:

    • Severity does not consistently predict outcomes, except for some findings in 4-5-year-old studies (Bostian et al, 2016; Walsh et al, 2018).

    • Conflicting data regarding age at onset and persistence.

  5. Temperament, Phonological, Motor & Language Skills:

    • Lack of clear evidence linking temperament with persistence in stuttering.

    • Some studies suggest phonological difficulties might correlate with persistence.

    • Emerging evidence suggests motor skills (such as speech rate and movement variability) may link to persistence, although data is contradictory regarding language development.

Implications of Research Findings

  • No Single Predictive Factor:

    • Multiple inconsistencies across populations and assessment methods.

    • If either the child or parents are anxious about stuttering, an assessment is recommended.

  • Note on Study Effectiveness:

    • Reference to the effectiveness study (Millard, Zebrowski & Kelman, 2018) indicates boys and those with a familial history of stuttering are found in more successful therapeutic categories.

Key Assessment Questions

  1. Confirm if the child stutters.

  2. Assess the impact of stuttering on the child and parents.

Framework for Assessing Stuttering

  • Multifactorial Model focusing on the child’s skills profile within the family context:

    • Physiological Factors: Family history, well-being, sleep, and health.

    • Speech Motor Factors: Skills related to speech production, rate, stammering type, and frequency.

    • Language & Communication Factors: Skills in language and social communication; discrepancies between advanced and delayed language development.

    • Psychological Factors: Temperament, awareness of stuttering, and parents’ anxiety levels.

    • Environmental Factors: Family communication dynamics, routines, and speech pace.

Assessment Goals

  • Establish severity regarding frequency and duration of stuttering behaviors observed.

  • Collect data through spontaneous speech samples; video recordings analyzed using the Stuttering Severity Instrument (SSI-4).

  • Utilize parental assessments of stuttering; explore their perceptions of severity impact on both child and family (Palin Parent Rating Scales, Millard & Davis, 2016).

Interaction Video Analysis

  • Focus on detailing strategies that support the child's fluency and communication skills.

  • Assess family dynamics and interactions from video review and select techniques parents are utilizing effectively.

Parent Involvement and Understanding

  • Parents engaged in assessment processes, obtaining hands-on experience on video interaction assessment, and case history documentation.

  • General education on stuttering and its contributory factors provided.

  • Collaborative creation of a therapy plan between therapists and parents emphasizing the individual child's needs.

Strategic Interaction Therapy Techniques

  1. Conciseness in Communication - Strategies for simplified language therapy and phonological interventions.

  2. Parent-Child Interaction Strategies:

    • Managing turn-taking during conversations, checking on timing and involvement.

    • Encouraging consistent eye contact and response strategies to stammering.

    • Strategies for emotional resonance and confidence-building through praise rather than criticism.

    • Discussions around how to address and normalize stuttering within family communication.

Special Times Technique

  • Introduces “Special Times,” designed for focused interaction periods between parents and children, not centered on stuttering, but on general play and interaction.

    • Daily practices tailored to frequency of interaction (3,4, or 5 times weekly).

Family Strategies for Support

  • Assisting families in recognizing their supportive behaviors and reinforcing those effects through feedback and education.

  • Handouts for parents prepared in advance to deepen understanding.

Direct Approaches to Stuttering

  • Parents encouraged to maintain openness in conversations about stuttering.

  • Enable children to express feelings regarding their stuttering.

Child-Focused Strategies

  • Aim to develop confidence in communication regardless of their stuttering.

  • Highlight importance of being open about stuttering, and desensitization to anxiety regarding it.

  • Facilitate understanding of the speech mechanism and typical stuttering processes.

Speech Modification Techniques

  • Tortoise Talking: Emphasizing rate reduction (Meyers & Woodford, 1992).

  • Bus Talking: Encouraging pauses for thought processing during conversation.

Adaptation of Palin PCI Therapy

  • Tailoring therapeutic approaches for families with different linguistic backgrounds.

  • Modifications for children with additional needs, such as Autism Spectrum Disorder or Selective Mutism.

Benefits of Palin PCI Therapy

  • Empowerment through the existing skills of parents; avoiding a burdensome learning curve for family members.

  • Establishing a ripple effect of improvement in communication confidence, not just fluency, benefits both children and parents.

References

  • Ambrose NG, Cox NJ & Yairi E, 1997 – Study on genetic implications in persistent stuttering.

  • Millard SK, Zebrowski P & Kelman E, 2018 – Comprehensive study on outcomes related to family history of persistence.

  • Relevant literature on dynamics of caregiver-child interactions and stuttering effects as detailed above.